Residential course on rehabilitation in multiple sclerosis · neurorehabilitation techniques in...

Residential course on rehabilitation inmultiple sclerosis6-7 October 2016 - Valens, Switzerland

RESIDENTIAL COURSEFINAL PROGRAMME AND ABSTRACT BOOK

Residential course on rehabilitation in multiple sclerosis

OverviewThis residential course is designed for neurologists, physiotherapists and physiatrists willing to learn about the most advancedneurorehabilitation techniques in multiple sclerosis (MS). Participants will learn about the metrics for the assessment of functioning inMS in order to plan a personalised and goal oriented rehabilitation programme. The second part of the course will address the evidencebased therapeutic interventions for motor, cognitive and social rehabilitation. The residential programme will be held in the KlinikValens which is a leading international academic training centre equipped with all the forefront technologies including a thermalswimming pool. Participants will have the unique opportunity to join the team of highly trained specialists in their everyday activities forpractical training sessions.

Learning objectivesBy attending this live educational course, participants will be able to: • Illustrate the biological basis of neurorehabilitation • Describe the main metrics for the assessment of motor disability in MS • Plan personalized rehabilitation programmes

Target audienceNeurologists, physiatrists, rehabilitation therapists currently involved in MS rehabilitation management.

ChairJürg KesselringDepartment of NeurorehabilitationRehabilitation CentreValens, Switzerland

Co-ChairPeter FeysRehabilitation Sciences and Physiotherapy University of HasseltCampus DiepenbeekAgoralaanDiepenbeek, Belgium

EXCEMED designed this programme in partnership with Valens Klinik.

Endorsed by RIMSRIMS “Rehabilitation in Multiple Sclerosis” is an international non-profit organization that was founded in 1991. It is an Europeannetwork for best practice and research, bringing together health care professionals, researchers and MS societies.

1

CME ProviderEXCEMED is a non profit foundation dedicated, since the last four decades, to the development of high-quality medical educationprogrammes all over the world.

EXCEMED adheres to the guidelines and standards of the European Accreditation Council for Continuing Medical Education (EACCME®)which states that continuing medical education must be balanced, independent, objective, and scientifically rigorous.

Continuing medical educationThe EXCEMED “Residential course on rehabilitation in multiple sclerosis” is accredited by the European Accreditation Council forContinuing Medical Education (EACCME®) to provide the following CME activity for medical specialists. The EACCME® is aninstitution of the European Union of Medical Specialists (UEMS), www.uems.net

The CME “Residential course on rehabilitation in multiple sclerosis” held on 6-7 October 2016 in Valens, Switzerland, is designatedfor a maximum of 11 (eleven) hours of European external CME credits (ECMEC). Each medical specialist should claim only thosehours of credit that he/she actually spent in the educational activity.

Through an agreement between the European Union of Medical Specialists and the American Medical Association, physicians mayconvert EACCME® credits to an equivalent number of AMA PRA Category 1 Credits™. Information on the process to convertEACCME® credit to AMA credit can be found at www.ama-assn.org/go/internationalcme.

Live educational activities, occurring outside of Canada, recognized by the UEMS-EACCME® for ECMEC credits are deemed to beAccredited Group Learning Activities (Section 1) as defined by the Maintenance of Certification Program of The Royal College ofPhysicians and Surgeons of Canada.

EXCEMED adheres to the principles of the Good CME Practice group (gCMEp).

2

General information

This live educational course takes place at:Multiple Klinik Valens RehabilitationszentrumCH-7317 Valens, Switzerland E-mail: [email protected]

LanguageThe official language of this live educational course is English.

CME ProviderEXCEMED - Excellence in Medical Education

Programme and Relations Manager: Giulia AnastasiaT +39 06 420413 315 - F +39 06 420413 [email protected]

Medical Advisor: Doriana [email protected]

For any logistic support please contact:

Meridiano Congress InternationalProject Manager: Giorgia Di EgidioT +39 06 88 595 232 - F +39 06 88595 [email protected]

3

Programme

5

Chairs: P. Feys (Belgium) - J. Kesselring (Switzerland)

Cognitive functioning

14.00 L5: Cognitive impairment profile and mooddisturbances

M.P. Amato (Italy)

14.30 L6: Neuropsychological tests batteries D. Langdon (UK)

15.00 L7: Cognitive rehabilitation aims and approaches P. Hämäläënen (Finland)

15.30 CC1: Clinical cases and practical exercises withcognitive assessment and rehabilitationplatforms

P. Hämäläënen (Finland) D. Langdon (UK)

16.20 Coffee break

16.40 Visit to Valens Klinik premises

17.30 End of the first day

The assessment of functioning and patient-oriented rehabilitation programmeSession III


09.15 L1: From neurorehabilitation to neuroplasticityand viceversa

G. Comi (Italy)

09.45 L2: Molecular and physical benefits of exercise inmultiple sclerosis

J. Kesselring (Switzerland)

10.15 Coffee break

-


Motor functioning and balance

10.45 S1: Balance assessments by MS C. Meier Khan (Switzerland)

11.05 S2: Gait and Walking Assessments by MS Y. Vila (Switzerland)

11.25 S3: Technical aids by MS C. Meier Khan (Switzerland)

11.45 L3: Upper and lower limbs motor rehabilitationaims and approaches

P. Feys (Belgium)

12.15 L4: Acquatic therapy U. Gamper (Switzerland)

12.45 Lunch

Biological basis of neurorehabilitationSession I

The assessment of functioning and patient-oriented rehabilitation programmeSession II

Thursday, 6 October 2016

08.45 Opening and introduction to the course G. Comi (Italy) - P. Feys (Belgium)

09.00 Introduction to MS rehabilitation center of Valens J. Kesselring (Switzerland)

Legend: L : Lecture; S : Snapshot; CC: Clinical Cases;

6

Friday, 7 October 2016


08.30 L8: Role of occupational therapy J. Ebert (Switzerland)

09.00 L9: Fatigue management A. Weise (Switzerland)


09.30 L10: Pelvic rehabilitation R. Althof (Switzerland)

10.00 L11: Dysphagia and swallowing rehabilitation S.J. Albert (Switzerland)

10.30 L12: Speech disturbances and rehabilitation S. Feil (Switzerland)

11.00 Coffee break


11.30 L13: Psychosomatic medicine and social factors V. Kesselring (Switzerland)

12.00 L14: Patient reported outcomes (PROs) A. Solari (Italy)

12.30 L15: ICF core set A. Weise (Switzerland)

13.00 Lunch

The assessment of functioning and patient-oriented rehabilitation programmeSession IV

The assessment of functioning and patient-oriented rehabilitation programmeSession V

Shared decision in rehabilitationSession VI


14.00 S4: Sport therapy J. Bansi (Switzerland)

14.20 S5: Hippotherapy A. Artuso (Italy)

14.40 CC2: Clinical cases about advancedneurorehabilitation, including an overviewabout how to plan an integrated rehabilitationprogramme

J. Kesselring (Switzerland) C. Meier Khan (Switzerland)

15.40 Final discussion and meeting wrap up

16.30 End of the course

Advanced neurorehabilitationSession VII

Disclosure of faculty relationships

7

EXCEMED adheres to guidelines of the European Accreditation Council for Continuing Medical Education (EACCME®) and all otherprofessional organizations, as applicable, which state that programmes awarding continuing education credits must be balanced,independent, objective and scientifically rigorous. Investigative and other uses for pharmaceutical agents, medical devices and otherproducts (other than those uses indicated in approved product labeling/package insert for the product) may be presented in theprogramme (which may reflect clinical experience, the professional literature or other clinical sources known to the presenter). We askall presenters to provide participants with information about relationships with pharmaceutical or medical equipment companies thatmay have relevance to their lectures. This policy is not intended to exclude faculty who have relationships with such companies; it isonly intended to inform participants of any potential conflicts so that participants may form their own judgements, based on fulldisclosure of the facts. Further, all opinions and recommendations presented during the programme and all programme-relatedmaterials neither imply an endorsement nor a recommendation on the part of EXCEMED. All presentations represent solely theindependent views of the presenters/authors.

The following faculty provided information regarding significant commercial relationships and/or discussions of investigational ornon-EMEA/FDA approved (off-label) uses of drugs:

Sylvan J. Albert Declared no potential conflict of interests.

Rixt Althof Declared no potential conflict of interests.

Maria Pia Amato Declared receipt of grant and contracts from Teva. She also declared receipt of honoraria or consultationfees from: Biogen, Teva, Merck Serono, Genzyne, Almirall, Novartis and to be member of a companyadvisory board, board of directors or other similar group: Biogen, Merck Serono.

Antonella Artuso Declared no potential conflict of interests.

Jens Bansi Declared no potential conflict of interests.

Giancarlo Comi Declared receipt of honoraria or consultation fees: Excemed, Merck, Novartis, Teva, Sanofi, Genzyme,Biogen, Roche, Almirall Chugai, Receptos, Forward Pharma.

Juliane Ebert Declared no potential conflict of interests.

Sarah Feil Declared no potential conflict of interests.

Peter Feys Declared receipt of honoraria or consultation fees from Teva. He also declared to be member of a companyadvisor board, board of directors or other similar group: Biogen-idec and participation in a companysponsored speaker’s bureau: Excemed.

Urs N. Gamper Declared no potential conflict of interests.

Päivi Hämäläinen Declared receipt of honoraria or consultation fees from Novartis.

Jürg Kesselring Declared no potential conflict of interests.

Verena Kesselring Declared no potential conflict of interests.

Dawn Langdon Declared receipt of grant and contracts from: Teva, Biogen, Novartis, Bayer. She also declared receipt ofhonoraria or consultation fees from: Biogen, Teva, Merck Serono, Almirall, Novartis, Roche andparticipation in a company sponsored speaker’s bureau: Roche, Biogen, Bayer, Almirall, Novartis, Merck,Teva.

Christine Meier Khan Declared no potential conflict of interests.

Alessandra Solari Declared receipt of honoraria or consultation fees from: Almirall, Merck Serono, Novartis, Senofi, Genzym,Teva. She also declared to be member of a company advisor board, board of directors or other similargroup: Biogen-idec, Merck Serono, Novartis.

Andrea Weise Declared receipt of grant and contracts: research grants of EVS (occ.therap. assoc. CH), stiftungergotherapy and MS association CH.

The following faculty have provided no information regarding significant relationship with commercial supporters and/or discussionof investigational or non-EMEA/FDA approved (off-label) uses of drugs as of 28 September 2016.

Yasmin Vila

Biographies

9

Sylvan J. Albert is Head of the Division of Neurology and Stroke Unit at Kantonsspital Graubünden. He is Senior Consultant atKliniken Valens Rehabilitationcenter, Switzerland. He completed his Medical Studies and Neurological Fellowship at the Universitiesof Essen (D), Düsseldorf (D), Witten Herdecke (D) and Bern (CH).

Sylvan J. Albert Department of NeurorehabilitationValens Clinic Rehabilitation CenterValens, Switzerland

Since 1991 Rixt Althof works as physiotherapist and continence therapist at the Rehabilitation Centre in Valens, Switzerland. Shespent her career in the pediatric, neurologic and geriatric departments of diverse hospitals in the Netherlands. During the last 24years she was able to participate in the development of a treatment-protocol for the neurological patients with an overall good andrewarding outcome, especially in Quality of Life.

Rixt AlthofDepartment of TherapyValens Clinic Rehabilitation CenterValens, Switzerland

Biographies

10

Maria Pia Amato obtained her medical degree at the University of Florence (Italy) in 1983 and became a Board Certified Neurologistin 1987. She received a specific training in clinical epidemiology as a Research Fellow at the Johns Hopkins University, Baltimore(USA) and at the Erasmus University, Rotterdam (The Netherlands). She is Associate Professor of Neurology since 2004 andresponsible for the MS Unit at the Department NEUROFARBA, Section of Neurosciences, University of Florence. Currently, she ismember of the Executive Committee of the European Committee for Treatment and Research on Multiple Sclerosis (ECTRIMS). Sheis actively involved in clinical research on MS, at both the national and international level, with focus on treatment, clinicalepidemiology and neuropsychology of MS and has published more than 200 scientific papers in peer reviewed journals.

Maria Pia AmatoDepartment of Neurological and Psychiatric SciencesUniversity of FlorenceFlorence, Italy

Antonella Artuso graduated in Physiotherapy and then in Medicine at the Università degli Studi of Milan presenting a thesis whichdealt with the role of Equestrian Rehabilitation in the disease of Autism. Specialized in Physical and Rehabilitative Medicine and inTherapy by means of Horse at the National Italian Association of Equestrian Rehabilitation (A. N. I. R. E.), since 1997 she’s beenworking in the department of Physical and Rehabilitative Medicine of Don Carlo Gnocchi Foundation of Milan. Since 1998 she’s beenworking at the Institute for Blind People of Milan by being in charge of the Rehabilitation Therapies for people admitted in theResidential House. From 1998 to 2013 Antonella Artuso has been the doctor in charge of the Equestrian Rehabilitation Service ofDon Carlo Gnocchi Foundation. She teaches at the A. N. I. R. E. Association and she’s part of the board of directors of the MasterCourse Educational and Rehabilitative Intervention helped by Animal provided by Università Cattolica del Sacro Cuore of Milan.

Antonella ArtusoDon Gnocchi Foundation Milan, Italy

11

Jens Bansi studied exercise science with primary focus on rehabilitation of neurological disorders at the German Sports Universityin Cologne, Germany where he also achieved his PhD in celluar and molecular sports medicine. Since 12 years he works for theKliniken-Valens. His therapeutical work involves reconditioning for adults with orthopedic, rheumatological or neurological disordersin aquatic- or overland settings. The research projects mainly focus the impacts of training on cardiorespiratory fitness and links thehigher fitness levels with better cognitive and immune functions in persons with multiple sclerosis.

Jens Bansi Department of TherapyValens Clinic Rehabilitation CenterValens, Switzerland

Giancarlo Comi is Professor of Neurology, Chairman of the Department of Neurology, and Director of the Institute of ExperimentalNeurology at Vita-Salute San Raffaele University, Milan, Italy. He is also President of the European Charcot Foundation (ECF), amember of the Board of Administration of the Italian Multiple Sclerosis Foundation and of the Scientific Committee of AssociazioneItaliana Sclerosi Multipla, Co-Chair of the Scientific Steering Committee of the Progressive MS Alliance, and a fellow of the EuropeanAcademy of Neurology (EAN). He has served as a past president of the European Neurology Society, the Italian Society of ClinicalNeurophysiology, and the Italian Society of Neurology. In recent years, Professor Comi has received the “Gh. Marinescu” honoraryaward from the Romanian Society of Neurology, and has been awarded honorary memberships of the Russian NeurologicalAcademic Society, the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), the EuropeanNeurological Society (ENS) and the Sociedad Espanola de Neurologia. He also received the Charcot Award for MS Research fromthe MS International Federation (MSIF) in 2015. Most recently, Professor Comi was awarded the Gold Medal of “BenemeranzaCivica” from the City of Milan. Prof. Comi has authored and co-authored more than 1000 articles in peer-reviewed journals, andedited several books. He has been the invited speaker for more than 450 conferences, both nationally and internationally. He sits onthe executive boards of various scientific associations and on the editorial boards of Clinical Investigation, European Journal ofNeurology and Multiple Sclerosis. He is also the Associate Editor of the Neurological Sciences.

Giancarlo ComiDepartment of NeurologyInstitute of Experimental NeurologyVita-Salute San Raffaele UniversityMilan, Italy

Biographies

12

Juliane Ebert studied Occupational Therapy at SRH Fachschule für Ergotherapie in Karlsbad-Langensteinbach, Germany and since2015 she’s attending the Msc cand. in Neurorehabilitation in Krems, Austria. Since 2013 she’s part of the Rehabilitation team ofKliniken-Valens. Juliane Ebert has been author of the published Ergopraxis (Ebert J., Hamilton L. Im Einhand-Modus - 04/2015).

Juliane Ebert Department of NeurorehabilitationValens Clinic Rehabilitation CenterValens, Switzerland

Sarah Feil studied at the University of Bielefeld, where she got a Bachelor of Science in 2009 and a Master of Science in 2012, bothin Klinische Lingusitik.For her Master Thesis she did a study about the influence of intensity of emotional prosodic information onemotion recognition of children with Asperger's syndrome. She worked as a caregiver, mostly in the Von Bodelschwingh'scheStiftungen Bethel, Bielefeld, Germany, a large medical and social institution for persons with epilepsy and various disabilities. Since2012 she‘s been working as a speech and language pathologist in a neurology rehabilitation centre in eastern Switzerland: KlinikValens, helping people in therapy to reach their individual goals and also carring out scientific research - e.g. a study of bi-hemispheric tDCS (transcranial direct-current stimulation) in people with post-acute aphasia after stroke, together with Dr. Myliusand other colleagues. Mrs Feil have always been intrigued by the diversity of the members of society and by the topic of inclusion.

Sarah Feil Klinische Linguistin M.Sc.Valens Clinic Rehabilitation CenterValens, Switzerland

13

Peter Feys is Professor Rehabilitation Sciences and Physiotherapy. Master in Physiotherapy (1994), with additional specialization inneurological rehabilitation (1995) and PhD in Rehabilitation Sciences and Physiotherapy (2004). Peter Feys has clinical, educationaland scientific experience in the treatment of patients with neurological deficits in general, and Multiple Sclerosis (MS) in specific. Heworked as clinical therapist in Bürgerspital Solothurn (CH), the University Hospitals Leuven and the National MS Centre inMelsbroek. MS Research is performed since 1998 at the National MS Centre Melsbroek and later on the “Katholieke UniversiteitLeuven”, funded by European projects, WOMS (Flemish MS Society) and the Fund for Scientific Research, Flanders. Peter Feys iscurrently Professor at the University of Hasselt, and is part of the REVAL rehabilitation research institute within BIOMED. He isresponsible for the master program in “Rehabilitation Sciences and Phsyiotherapy”. Research is focusing on assessment andrehabilitation for gait and upper limb function, motor fatigue, motor imagery, upper limb rehabilitation including the use oftechnology (www.I-TRAVLE.eu) and community self-directed training in persons with neurological conditions (multiple sclerosis asfocus added with co-work in stroke and Parkinson disease). Since recently, neuro-imaging is performed within translationalresearch collaborations to understand the potential of neuroplasticity in neurodegenerative diseases. Internationally, he is Presidentof R.I.M.S. (stands for Rehabilitation in MS, an European network of best practice and research, www.euRIMS.org), after beingChairman of the Special Interest Group on Mobility from 2008 till 2011. He serves as management committee member in the COSTaction TD1006 (European Network on Robotics for NeuroRehabilitation, 2011-15) and is part of the scientific committee of the ItalianMS Society (AISM/FISM). He is editorial board member of “Multiple Sclerosis Journal”. Nationally, he is secretary of “Move to Sport”(www.movetosport.be) and member of the “MS Steunfonds” (MS Society Flanders). Peter Feys has published 80 peer reviewedarticles in international clinical neurological, imaging and rehabilitation journals.

Peter FeysRehabilitation Sciences and Physiotherapy University of Hasselt, Campus Diepenbeek, AgoralaanDiepenbeek, Belgium

Urs N. Gamper since 1990 is head of Therapy Department of Valens Clinic, Rehabilitation Centre, CH-Valens and member of theexecutive board of Valens Clinics, Rehabilitation Centre, CH-Valens since 2004. The major interest of his studies is the aquatictherapy in the fields of neurological and musculoskeletal disorders in adults. Urs N. Gamper has been honored with prizes andrecognitions: 2010 Physiotherapy Association Switzerland, 2012 Swiss Leag against Rhumatism and 2014 Health Professionals inRheumatology Switzerland.

Urs N. GamperDepartment of TherapyValens Clinic Rehabilitation CenterValens, Switzerland

Biographies

14

Päivi Hämäläinen works as a neuropsychologist in Masku Neurological Rehabilitation Centre since 1990 (neuropsychologicalassessments, counselling and rehabilitation) and as head psychologist since 1999. Clinical and research supervisor for severalneuropsychologists working with MS patients or making scientific work on cognitive impairments in MS and other neurologicaldiseases. Supervisor in Lic. studies: Seinelä Arja, Helin Pia, Rosti-Otajärvi Eija, Multanen Johanna, Okker Elina, Huolman Sini,Hankomäki Elina, Liuha Sanna, Ikonen Anna, Suomalainen Susanna, Mäntynen Anu, Elina Castren, Kati Mäkinen. Supervisor in PhDstudies: Rosti-Otajärvi Eija (PhD), Himanen Leena (PhD), Huolman Sini, Saarenketo Anna-Riitta, Liuha Sanna. Official opponent inPhD studies: Koskinen Sanna, Kettunen Jani, Rapeli Pekka, Kjersti Troeland-Hanssen, Heidi Losoi. Head of the Masku neurologicalrehabilitation centre since 2011. Chair of the RIMS Special Interest Group in Psychology and Neuropsychology 2001-2010, as a co-chair 2010-2011. Member of the steering committee of the Finnish Neuropsychological Society 2006-2012. Member of theNeuropsychological work group in the Finnish Psychology Association 2005-2011. Member of the medical and neuropsychologicalsteering groups of the Finnish National Insurance Institution’s VAKE –project (Project to develop rehabilitation for severelyhandicapped patients with MS, stroke and CP). Member of the Executive board of the Rehabilitation in Multiple Sclerosis (RIMS)2011-2014 (secretary), 2014 – (SIG coordinator). Member of the Executive Board of the International MS and Cognition Society(IMSCogS). Member of the Advisory Board of the University of the Applied Sciences in Turku (Health Care and Social sciences) from2015.

Päivi HämäläinenMasku Neurological Rehabilitation CentreMasku, Finland

Jürg Kesselring is Head of Department of Neurology & Neurorehabilitation at the Rehabilitation Centre in Valens, Switzerland andProfessor of Clinical Neurology and Neurorehabilitation, University of Bern, Lecturer in Clinical Neuroscience at the Center ofNeuroscience, University and ETH Zürich, Chair of neurorehabilitation, San Raffaele University, Milano, Italy and at Danubeuniversity, Krems, Austria. He is a Member of the Assembly of the International Committee of the Red Cross, and former Presidentof the Swiss Multiple Sclerosis Society and former Chairman of the International Medical and Scientific Board of Multiple SclerosisInternational Federation (MSIF) and of the Resarch Committee on Demyelination of the World Federation of Neurology (WFN),Chairman of the WHO Working Group on Multiple Sclerosis (-2005), former President of the European Committee on Treatment andResearch in Multiple Sclerosis (ECTRIMS). Author of 180 Originalpublications and Editor or Co-Author of 15 books, mainly related toMultiple Sclerosis, Neurorehabilitation, Magnetic Resonance Imaging.

Jürg KesselringDepartment of NeurorehabilitationValens Clinic Rehabilitation CenterValens, Switzerland

15

Verena Kesselring is Senior Physician in Neurology at Kliniken Valens Rehabilitationcenter in Valens, Switzerland – since 1999 - andMD specialist in internal medicine, FA Psychosocial und Psychosomatic Medicine SAPPM. She works at Kantonsspital St. Gallen andSchaffhausen (internal medicine), Universityhospital Bern (neurology) and Munsingen und Zurich (psychiatry). Since 1999 seniorphysician in Neurorehabilitationcenter Valens, Psychosomatics Neurology. Member of the Swiss Working Committee forPsychosocial and Psychosomatic Medicine SAPPM; member of the FMH Internal Medicine and of the executive board “VereinWohnen und Arbeiten mit Behinderung OVWB St. Gallen”. Since 2000 she is lecturer at academy of Physiotherapy in Landquart.From 1995 to 2014 sh’s been lecturer at academy of Medical engineering in Buchs (NTB).

Verena KesselringDepartment of NeurorehabilitationValens Clinic Rehabilitation CenterValens, Switzerland

Dawn Langdon completed her training as a clinical psychologist at Oxford University and the Institute of Psychiatry, London. Sheworked as a clinical neuropsychologist at the National Hospital for Neurology and Neurosurgery, Queen Square, London for sixteenyears, obtaining a PhD on reasoning in organic brain syndromes from the Institute of Neurology and registration as both aneuropsychologist and a health psychologist. She is now Professor of Neuropsychology and Director of Health and Medicine at RoyalHolloway, University of London. She is neuropsychology lead on a number of multinational trials for the pharmaceutical industry.She has worked extensively on psychological aspects of MS, including measurement of cognition and it’s relation to pathology andother disease variables. She is also investigating how risks and benefits of MS medication are best communicated to patients.Another interest is how employment relates to cognition in MS. She has published over 60 peer-review articles and has an h-indexof 30. She is a frequent contributor to international scientific meetings and committees and is a Trustee of the UK MS Trust, withwhom she has authored the MS cognition website www.stayingsmart.org.uk. She is co-chair of Brief International CognitiveAssessment for MS initiative (www.BICAMS.net) and Secretary of the International MS Cognition Society (www.IMSCOGS.com). Sheis Mental Health Work Package Lead on the NHS England Community Neurology Project and an author on the project’s recentcommissioning guide (http://www.neural.org.uk/nhs-england-community-project-for-neurology).

Dawn LangdonDepartment of PsychologyRoyal Holloway University of LondonLondon, UK

Biographies

16

Christine Meier Khan studied physical therapy at the Kantonsspital Basel from 1993-1997. Since 1998 she has been working in theRehabilitation Clinic Valens, the first two years in the rheumatological department and since 2000 in the neurological department.From 2009-2012 she completed a Masters Degree (MSc) in neurorehabilitation at the university of Krems, Austria. She specialisedin Constraint Induced Movement Therapy, Facio-oral-Therapy, early rehabilitation and motor learning.

Christine Meier KhanDepartment of NeurorehabilitationValens Clinic Rehabilitation CenterValens, Switzerland

Alessandra Solari’s main area of research is the validation of instruments and outcome measures (chiefly patient-reported outcomemeasures) for clinical, epidemiologic, and quality of care studies in neurological diseases, particularly multiple sclerosis. Her othermain interest is the design, conduction and analysis of randomised controlled trials on rare diseases and on complex interventions.She has published in leading medical journals, including Lancet Neurology, Neurology, Brain, and Multiple Sclerosis Journal.

Alessandra Solari Unit of NeuroepidemiologyFoundation IRCCS Neurological Institute C. BestaMilan, Italy

17

Yasmin Vila works as physiotherapist at Kliniken Valens Rehabilitation Center in Valens, Switzerland - Department ofNeurorehabilitation.

Yasmin VilaDepartment of NeurorehabilitationValens Clinic Rehabilitation CenterValens, Switzerland

Since 2013, Andrea Weise is head of occupational therapy neurology of the Rehabilitation Centre in Valens. Since 2010 Dr. Weise ishead of Professional Master in Occupational Therapy (MAS) & Teacher Post-BSc-Education at Zurich University of Applied Sciences.Since 2016, part of the Development of in-patient education program about fatigue management and pilot-RCT, Dr. Weise have alsobeen part of the focus groups project about professional terminology of occupational therapists in Switzerland (2011-12&16). Dr.Weiss’s been co-researcher in research projects for the development of the ICF Core Sets for Multiple Sclerosis: empirical multi-center cross-sectional study with patients - delphi design with international health professionals - consensus conference withinternational experts. In 2006-2007 Dr. Weiss developped trans-national delphi design study with people with Multiple sclerosis aboutenvironmental factors facilitating and hindering their participation.

Andrea WeiseDepartment of NeurorehabilitationValens Clinic Rehabilitation CenterValens, Switzerland

Abstracts

19

Abstract not in hand at the time of printing.

L1. From neurorehabilitation to neuroplasticity andviceversa

Giancarlo ComiDepartment of Neurology, Institute of Experimental Neurology, Vita-Salute San Raffaele University, Milan, Italy

20

Re-organisation of structures and functions in the brain are the basis of learning. Plastic changes occur in normal as well as indiseased brains and can be enhanced by task-specific therapeutic interventions (Neurorehabilitation). Due to the variety ofsymptoms and functional deficits Multiple Sclerosis (MS) can lead to a broad range of functional impairments and handicap. Evenwith newer immunomudulating therapies, the course remains progressive. The symptoms themselves, loss of independence andparticipation in social activities are responsible for the progressive decline of quality of life. The main objective of a comprehensiverehabilitation program is to ease the burden of disease by improving self performance and independence. Restoration of function isnot the key effect of rehabilitation in MS. As rehabilitation measures have no direct influence on the ongoing disease process andprogression of the disease, compensation of functional deficits, adaptation and reconditioning together with other nonspecific effects(management of specific symptoms and impairments, emotional coping, self estimation) is more important in the longterm. Severalof the many symptoms of MS are amenable to drug therapies which have been proven in careful evidence-based analyses to beeffective (e.g. fatigue, spasticity, bladder, bowel and sexual disturbances, pain, cognitive dysfunctions etc). Newer studies in MSpatients show, that despite the ongoing progression of the disease process, rehabilitation is effective by improving personal activitiesand participation in social activities leading to better quality of life. After comprehensive inpatient rehabilitation, improvementoverlasts the treatment period for several months. Quality of life is correlated more with disability and handicap rather than withfunctional deficits and progression of the disease.

References:- Kesselring J, Comi G, Thompson AJ Multiple Sclerosis - functional recovery and neurorehabilitation. Cambridge University Press 2010 - Serafin Beer, Fary Khan, Jürg Kesselring Rehabilitation interventions in Multiple Sclerosis An overview. J Neurol 2012 DOI 10.1007/s00415-012-6577-4- Mostert S, Kesselring J Effect of pulsed magnetic resonance therapy on the level of fatigue in patients with multiple sclerosis – a randomised controlled trial.Multiple Sclerosis 2005; 11: 302-305

- Kesselring J, Beer S Symptomatic therapy and Neurorehabilitation in multiple sclerosis. The Lancet Neurology 2005; 4 (10); 643-652- Meyer-Heim A, Rothmaier M, Weder M, Kool J, Kesselring J Advanced cooling - garment technology: functional improvements in thermosensitive patients withMultiple Sclerosis. 2006; 12: 1 – 6

- Kesselring J, Coenen M, Cieza A, Thompson A, Kostanjsek N, Stucki G Developing the ICF Core Sets for Multiple Sclerosis to specify functioning. Multiple Sclerosis2008;14: 252-4

- Holper, Coenen M, Weise A, Stucki G, Cieza A, Kesselring J Characterizing functioning in MS using the ICF. J Neurol 2010; 257: 103 – 113 - Stützer P, Kesselring J - Wilhelm Uhthoff – a phenomenon - Int MS J 2008; 15; 90 - 93- Beer S, Manoglou D, Aschbacher B, Kool J Kesselring J Robot-assisted gait training in MS – a randomised controlled trial. Multiple Sclerosis 2008; 14:231 –236

L2. Molecular and physical benefits of exercise inmultiple sclerosis

Jurg KesselringDepartment of Neurorehabilitation, Valens Clinic Rehabilitation Center, Valens, Switzerland

21

Increasing pressure from health insurances and society and limited financial resources force care givers to shorten therapies.Furthermore therapists are obliged to provide effective, economic and purposeful therapy. Appropriate assessments are thereforerequired to assess the health problems of pwMS and to establish an efficient treatment plan. Assessments either diagnose andspecify the problem, or evaluate treatment-success and outcome, or give a prognosis of the course of the disease or health problem.

An assessment is appropriate if it is clinically relevant, fulfils psychometric properties, and is practicable. The ICF (internationalclassification of functioning, disability and health) provides a unified and standard language and framework for the description ofhealth. Its components of functioning and disability are described within the constructs of body functions/structures, activities andparticipation.

More than 70 assessments on all 3 ICF-levels are edited in a very valuable guidebook for the assessment of all neurologicaldisorders: “Assessments in Rehabilitation, volume 1 Neurology“. The assessments considered most important for pwMS arepresented in the lecture, such as the Expanded Disability Status Scale, Multiple Sclerosis Questionnaire for Physical Therapists, BergBalance Scale and Clinical Test for Sensory Interaction in Balance. Psychometric properties of the tests, practical information andrecommendations for the user will be discussed.

S1. Balance assessments by MS

Christine Meier KhanDepartment of Neurorehabilitation, Valens Clinic Rehabilitation Center, Valens, Switzerland

22

Abstract not in hand at the time of printing.

S2. Gait and Walking Assessments by MS

Yasmin VilaDepartment of Neurorehabilitation, Valens Clinic Rehabilitation Center, Valens, Switzerland

23

The goal of neurological rehabilitation is to support pwMS returning to the highest possible level of functioning and independence,whilst improving the overall quality of life.

The role of the therapist is to restore function such as strength and range of motion and to enable activities such as walking andtransfers from bed to wheelchair. Technical aids compensating lost function are used to alleviate daily life and to improve socialparticipation. MS as a chronic and progressive disease requires individual solutions for both restoration and compensation.Therefore the therapist evaluates the appropriateness of technical aids at regular intervals.

It is a challenge for the therapist to select which technical aid will support the patient to perform better in daily activities. For pwMSit is sometimes difficult to accept technical aids as for them it requires acceptance of deteriorated function and progress of thedisease. Therapists have to take patients’ expectations and fears into account and guide pwMS in their process of coping with thedisability and discovering new possibilities that technical aids may give.

A variety of technical aids to support mobility and walking is presented and discussed in this lecture. Aspects of safety at home areaddressed. Finally, devices to be used during therapy sessions are presented.

S3. Technical aids by MS

Christine Meier KhanDepartment of Neurorehabilitation, Valens Clinic Rehabilitation Center, Valens, Switzerland

24

The presentation will focus on defining aims for upper and motor limb rehabilitation, and present an overview of evidence ofrehabilitation strategies.

The ICF classification of functioning, with a core set of categories on different levels,1 can be used for defining the treatment aims ina joint discussion of the person with MS and the health care professional. Standard tests and patient reported questionnaires relatedto the treatment aims are applied at baseline to judge the severity of the dysfunction and the effects of treatments. For both upperand lower limb motor rehabilitation, a distinction will be made between capacity and performance.

An overview of the evidence related to upper limb rehabilitation will be provided based on the systematic review of Lamers et al.2

While there were many pilot studies being performed, large RCT targeting impaired upper limb function are few. Positively, a neuralpreservation after task-oriented training was shown. Strikingly, most studies were describing unilateral training methods whileupper limb function often requires bimanual skills for successful execution.

Illustration of effective rehabilitation strategies for lower limb function and gait will be provided. Here, attention will be given tointerventions at early disease stage, as well as the need for inclusion of behavioral change techniques if one aims to improve lifestylephysical activity.3 Finally, it will be discussed whether one should consider cognitive-motor interference to be assessed duringwalking, and perhaps even challenged during rehabilitation programs.4 Overall, there is increased evidence that physical trainingmay also have beneficial effects on specific cognitive functions.

References:1. Kesselring J, Coenen M, Cieza A, Thompson A, Kostanjsek N, Stucki G. Developing the ICF Core Sets for multiple sclerosis to specify functioning. MultScler2008;14:252-254.

2. Lamers I, Maris A, Severijns D, et al. Upper Limb Rehabilitation in People With Multiple Sclerosis: A Systematic Review. Neurorehabil Neural Repair 2016.3. Motl RW. Lifestyle physical activity in persons with multiple sclerosis: the new kid on the MS block. MultScler 2014;20:1025-1029.4. Leone C, Patti F, Feys P. Measuring the cost of cognitive-motor dual tasking during walking in multiple sclerosis. Mult Scler 2015;21:123-131.

L3. Upper and lower limbs motor rehabilitation aims andapproaches

Peter FeysRehabilitation Sciences and Physiotherapy, University of Hasselt, Campus Diepenbeek, AgoralaanDiepenbeek, Belgium

25

Aquatic therapy is often recommended for patients with neuro-motor difficulties in addition to land treatment. There are someadvantages, which rise from the hydrophysical properties, which you have to use in the therapy. Pool immersion has effects oncardio-vascular-, breath- and nervous- system. These effects increase the blood flow in the brain and appear to improve learning.

Buoyancy, hydrostatic pressure, viscosity, turbulences, waves and temperature support therapy especially for severely disabledpeople. Well-educated physio- and occupational therapists know how to use these forces in a treatment session. One of the mostimportant advantages in comparison to treatment on dry land is the null risk of falls. Moreover, as movements in the water areslower, patients have more time to think about how to plan and adjust movements and reaction strategies. This is very helpful forpatients with balance problems. Buoyancy helps to activate weak muscle groups in functional activities. Many patients are able towalk in chest deep water without help, so they can improve their postural control. For sedentary patients the immersion effect iscomparable to a low level cardio-vascular training in terms of cardiac output. Therapy in a pool with temperature between 24 and32°C positively influences the thermo-sensitivity. The optimal water temperature is not established for MS patients, as literatureabout the application of water therapy in MS is very scarce. The few papers available demonstrates that it improves balance andincreases neuroprotection.

L4. Acquatic therapy

Urs N. GamperDepartment of Therapy, Valens Clinic Rehabilitation Center, Valens, Switzerland

26

The subtle and often insidious changes in cognition, unspoken of for years and seen in all subgroups of Multiple Sclerosis (MS)irrespective of age or disease pattern, are finally being given the profile and importance their impact warrants. Cognitiveimpairments have been reported in 40% of population-based studies and >65% of clinically-based studies. They are not exclusivelya late phenomenon in the disease course and can be identified in patients who are at the beginning of their disease, although theytend to progress in the long-term and are usually prominent in the progressive phases of the disease. The neuropsychological profileis characterized by defects of information processing speed, working memory, long-term, episodic visual-spatial and verbalmemory, and aspects of executive functioning, whereas language and general intelligence are usually spared. Usually, informationprocessing speed and episodic memory are more affected in the early stages of the disease, whereas progressive patients can exhibitmore severe and widespread deficits involving a large variety of cognitive domains. Pediatric-onset MS subjects can also exhibitcognitive impairment in approximately 30% of the cases. The profile of cognitive impairments in the pediatric population largelyoverlaps that known in adults with MS, although language and intelligence quotient can be involved, particularly in those who areyounger at the onset of the disease. Mood disorders are also frequent in MS patients and are associated with considerable morbidityand mortality. Major depression can affect up to 50% of patients over the course of their life with MS. Looking beyond the fullsyndrome of major depression, clusters of depressive symptoms are frequently found (sub-syndromal depression). The etiology ofMS-related depression is multifactorial, including both psychological and biological factors. The importance of detecting andtreating the depressed patient is underscored by the high suicide rate in MS. In a disease without cure, good management translatesinto good symptoms management. In the case of mood disorders, the benefits to patients’ quality of life are considerable anddemand attention.

L5. Cognitive impairment profile and mood disturbances

Maria Pia AmatoDepartment of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy

27

The pattern of cognitive difficulties in MS, with information processing speed and memory being the most prevalent and mostseverely affected domains, make detection problematic in casual conversation and even at routine consultation. Patient self-reportof cognitive deficits is confounded by depression. Objective assessment on valid and reliable scales is therefore necessary. Several“gold standard” batteries are available, but they tend to be lengthy and require administration by a neuropsychologist. BICAMS(www.BICAMS.net) is a 15 minute cognitive tool that can be utilised in most MS clinics. There are 28 countries in the nationalvalidation pipeline (11 of these published or in press). In all countries which have compared BICAMS to the 90 minute MACFIMSbattery, BICAMS has demonstrated equal sensitivity to cognitive impairment.

References:- Benedict RH, Amato MP, Boringa J, Brochet B, Foley F, Fredrikson S, Hamalainen P, Hartung H, Krupp L, Penner I, Reder AT, Langdon D. Brief InternationalCognitive Assessment for MS (BICAMS): international standards for validation. BMC Neurol. 2012 Jul 16;12:55.

- Langdon DW, Amato MP, Boringa J, Brochet B, Foley F, Fredrikson S, Hämäläinen P, Hartung HP, Krupp L, Penner IK, Reder AT, Benedict RH.Recommendations for a Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS). Mult Scler. 2012 Jun;18(6):891-8.

- Langdon D. A useful annual review of cognition in relapsing MS is beyond most neurologists - NO. Mult Scler. 2016 May;22(6):728-30.

L6. Neuropsychological tests batteries

Dawn LangdonDepartment of Psychology, Royal Holloway University of London, London, UK

28

Cognitive deficits are common symptoms in multiple sclerosis (MS), and evident even in the early phases of the disease. Cognitivefunctions most frequently affected are information processing, memory and learning, attention, and executive functions. Deficits mayhave a multidimensional impact on quality of life by weakening the ability to work, impairing social functioning, and increasing thestrain of the caregiver. To date no effective pharmacological treatment for cognitive decline has been established.Neuropsychological rehabilitation aims at 1) reducing cognitive deficits; 2) reducing the harmful effects of cognitive impairments;and 3) supporting patients' awareness and ability to take cognitive impairments into account in daily living. Neuropsychologicalrehabilitation has been found effective in patients with stroke and traumatic brain injury. The presentation discusses the evidence onneuropsychological rehabilitation in MS based on recent systematic literature reviews and suggests models for alleviating the effectsof cognitive impairments in MS. The preliminary research evidence on the effects of neuropsychological rehabilitation in MS ispositive: rehabilitation may have favorable effects on patient’s cognitive performance and coping with cognitive impairments whichmay be manifested also as improved functioning of neural network. In clinical practice, both diagnostics and treatment of cognitiveimpairments should be improved. Neuropsychological rehabilitation should be an important part of rehabilitation regimen in MS.

L7. Cognitive rehabilitation aims and approaches

Päivi HämäläinenMasku Neurological Rehabilitation Centre, Masku, Finland

29

Often the OT has a role in the later stages of the MS, EDSS 5> 6, where the patient may well be dealing with issues such asdiminishing strength, losing independence in the activities of daily living (ADL) and Fatigue. The OT covers important, but perhapsless obvious issues of MS patients (life roles, relationships, etc.).

When the OT engages the person in the therapeutic process, she discovers who the person is, what his/her life roles and routinehabits are and how the environment impacts on daily activities;. In other words the OT builds an overall picture of the individual levelof “occupational performance & daily demands”.

The Case report will demonstrate how intense OT can increase independence and improve the performance in some daily livingactivities, also through the use of simple devices and strategies.

L8. Role of occupational therapy

Juliane EbertDepartment of Neurorehabilitation, Valens Clinic Rehabilitation Center, Valens, Switzerland

30

In the Clinical Practice Guidelines of the Multiple Sclerosis (MS) Council, fatigue is defined as “a subjective lack of physical and/ormental energy that is perceived by the individual or caregiver to interfere with usual and desired activities”. Several prevalencesurveys showed that fatigue is reported by 70% to 90% of the people with MS, and half of them consider this as their most disablingsymptom (Weiland et al., 2015 ; Bergamaschir et al., 2007). Fatigue limits the ability to participate in everyday activities, the corebusiness of occupational therapists, is a source of psychological distress and impairs quality of life, too (Kos et al., 2008).

Because this symptom is so common, but variable and inconsistent, even within individuals, measuring and managing fatigue is acritical and challenging task for health professionals providing care to people with MS. It requires a multidisciplinary rehabilitationfor successful management (Asano et al., 2014). In addition to physical exercises (Bansi et al., 2013) and the use of drugs, fatiguemanagement education based on a cognitive behavioural therapy approach is considered the most promising intervention to reduceits impact on occupational performance and quality of life (Craig et al., 2008 ; Mathiowetz et al., 2005). A patient education based onenergy conservation strategies and focused on the occupational performance will be presented.

L9. Fatigue management

Andrea WeiseDepartment of Neurorehabilitation, Valens Clinic Rehabilitation Center, Valens, Switzerland

31

Bladder Dysfunction is common in MS, affecting 80% - 100% of patiens during the course of the disease and has a severe effect onthe patients' quality of life. Bowell Dysfunction occurs with up to 40%.

Bladder Dysfunction Symptoms are urgency, frequency, incontinence, nocturia, hesitancy, postvoidal residue. Bowel DysfunctionSymptoms are constipation and faecal incontinence.

Both Bladder and Bowel Dysfunction have effect on fatigue, gait control, spasticity, pain, depression and sexual activity.

The therapeutic interventions are most effective with a multidisciplinary approach and should be offered by special educated healthprofessionals. Patient education and simple and helpful interventions are to be individual and close monitored with the possibilitythat symptoms will recur or develop de novo.

Possible physiotherapeutic interventions are:

• Pacing of micturiction and fluid intake

• Pelvic floor muscle training

• Relaxation and breathing techniques

• Mobility and manual dexterity training

• Biofeedback and or electrical stimulation

• Advice on absorbent incontinence pads and urinals

• Clean Intermittent Self Catherisation (CISC)

• Trans Anal lrrigation

The symptoms of most patients with OAB (Over Active Bladder) can be managed conservatively. Medical management in the formof anticholinergic therapy is effective.Intravesical administration of capsaicin or botulinumtoxin may be beneficial when first-line treatment is ineffective.

The overall goal is to maintain the patient’ dignity and self esteem and so optimise the quality of life.

L10. Pelvic rehabilitation

Rixt AlthofDepartment of Therapy, Valens Clinic Rehabilitation Center, Valens, Switzerland

32

Dysphagia is a frequent, though potentially overlooked symptom of patients with Multiple Sclerosis (MS). While it regulary affectspatients with severe disability, it can also occur in an early stage of the disease, due the possibly widespread involvement of cerebralstructures of the inflammation. Dysphagia in MS patients is very frequent, ranging about 30-40% overall Further complications arethe possibility of incidence of bolus, leading to acute blockage of airways (and severe vagal reaction), pneumonia due to aspiriation,malnutrion and/or dehydration, drooling, pain, discomfort. Because of the high importance of food intake, not only in terms ofnutrition, an individual assesment of dyphagia in suspected patients is mandatory. Despite of emerging reports in the last decade itis still supposed to be largely overlooked. Though it affects patients with a higher EDSS, about 15% of patients in an early stage seemto suffer from dysphagia. Detection can be performed by medical history / anamnesis and the rate of detection may be higher usingclinical or even technical examination methods. In detected dysphagia in MS compensatory strategies were reported to be sufficientto resolve the dysphagia in >90%. Such additional strategies can include modification of food, swallowing techniques, action againgsthypersalivation.

L11. Dysphagia and swallowing rehabilitation

Juliane EbertDepartment of Neurorehabilitation, Valens Clinic Rehabilitation Center, Valens, Switzerland

33

Patients with Multiple Sclerosis can be impaired in their ability to communicate because of a speech disorder called dysarthria.Dysarthria starts after a normal speech development because of a neurological damage in the central or peripheral nervous-system(Nospes & Olthoff 2014). It results in a disability in the muscles using for speech production and in a reduced intelligibility, which isassociated with less ability to take part in communication situations. Because of this, patients have a high risk to come in socialisolation (American Speech-Language-Hearing Assoziation (ASHA)).

Dysarthria in Multiple Sclerosis has a prevalence of 40-50% (Ziegler 1998). The most frequent forms in Multiple Sclerosis areSpasmodic Dysarthria and Ataxic Dysarthria (often mixed) (Henze et al. 2004).

For the diagnosis of Dysarthria it's necessary to examine different speech-associated functions like respiration, phonation,articulation, resonance and prosody. Also, you have to examine the function of the relevant muscles of the tongue, the lips, the velum,the larynx and the face. There are standard assessments like the Frenchey Dysarthria Assessment (Enderby & Palmer 2008) or theMunich Intelligibility profile (Ziegler et al. 1993), but also self-constructed assessments of speech and language pathologists whichexamine the relevant functions and especially the intelligibility of spoken words, sentences and texts are often used.

To improve the patient’s intelligibility is the most important therapy-goal for patients with Dysarthria.

For German speaking patients there are only very few evidence based methods. Speech therapy in Dysarthria is often based onsingle case studies (Guidelines DGN 2012).

Speech and language pathologists usually first try to improve intelligibility by training the impaired functions and advising thepatients how to change their mode of speaking in order to improve intelligibility. Also advising their relatives can be useful. Drugsand surgical methods can sometimes also be helpful: e.g. drugs that reduce saliva or a special prosthesis for the velum.

If in Multiple Sclerosis about 50% of spoken language is not intelligible, it should be useful to look for alternative means ofcommunication (Henze 2004). This could be a special computer or for example simply an app on a tablet computer. It is importantto work together with ergo-therapists and neuro-psychologists in order to find strategies suitable to the cognitive and motor level ofthe patient.

All in all the main goal is to make sure that people are able to communicate either verbal or with alternative means, because abilityto communicate is the key to social participation.

L12. Speech disturbances and rehabilitation

Sarah FeilKlinische Linguistin M.Sc., Valens Clinic Rehabilitation Center, Valens, Switzerland

34

The diagnosis of a neurological disease is always a heavy burden and emotional distress for persons affected and their relatives.There are different ways to cope with the impairment and the subsequent problems, disadvantageous ones and more favourableones. The knowledge and training of coping strategies may sooth some of the difficulties persons with MS suffer from.

Depression, emotional lability and anxiety are common comorbidities in pwMS. It is important to pay attention to those problemsand to check them with patients. Possible causes, symptoms and therapeutic options are explained.

The presentation brings into focus interactions between physical alterations and mental state on an organic as well as on apsychological basis. Certain physical and mental limitations caused by illness interfering especially with social life are highlighted,such as impaired cognitive ability and affective disorders. Emphasis is placed on favourable coping strategies illustrated with thehelp of some examples.

L13. Psychosomatic medicine and social factors

Verena KesselringDepartment of Neurorehabilitation, Valens Clinic Rehabilitation Center, Valens, Switzerland

35

In addition to conventional clinical endpoints, patient-reported outcomes (PROMs) have gained importance in both clinical researchand routine care 1,2. By providing information from a unique perspective, PROMs enable clinicians to obtain a better understandingof their patients and to inform clinical decision making. This is the case for multiple sclerosis (MS), which typically affects variousfunctional domains and causes significant disability and impact on quality of life, QOL3,4. PROMs are all-relevant endpoints for MSrehabilitation, as the ultimate goal of rehabilitation interventions is to improve MS symptoms, and to enhance patient functionalindependence and societal integration5.

QOL measures are a type of PROM characterized by multidimensionality, as they address a minimum of three key dimensions:physical, psychological and social. Individualized QoL measures differ from traditional inventories in that QOL domains are notpredetermined, but identified by the individual6.

The use of QOL inventories in the MS field has improved over recent years: several MS-specific tools are now available7,8, andindividualized measures have been also applied in this population9-12. Nonetheless, while the use of QOL measures in research iswell established, many challenges lie ahead as their use is extended to routine MS care3.

References:01. Doward LC, Gnanasakthy A, Baker MG. Patient reported outcomes: looking beyond the label claim. Health Qual Life Outcomes 2010; 8:8902. Black N, Burke L, Forrest CB, et al. Patient-reported outcomes: pathways to better health, better services, and better societies. Qual Life Res 2016; 25:1103–111203. Solari A. Role of health-related quality of life measures in the routine care of people with multiple sclerosis. Health Qual Life Outcomes 2005; 3: 1604. Rothwell PM, McDowell Z, Wong CK, Dorman PJ. Doctors and patients don't agree: cross sectional study of patients' and doctors' perceptions and assessments

of disability in multiple sclerosis. BMJ 1997;314:158005. Beer S, Khan F, Kesselring J. Rehabilitation interventions in multiple sclerosis: an overview. J Neurol 2012; 259: 1994–200806. Patel KK, Veenstra DL, Patrick DL. A review of selected patient-generated outcome measures and their application in clinical trials. Value in Health 2003; 6(5):

595–60307. Kuspinar A, Rodriguez AM, Mayo NE. The effects of clinical interventions on health-related quality of life in multiple sclerosis: a meta-analysis. Mult Scler 2012.

DOI: 10.1177/1352458512445201 08. Solari A. Quality of life reporting in multiple sclerosis clinical trials: enough quality? Multiple Scler 2012; 18(12): 1668–166909. Lintern TC, Beaumont JG, Kenealy PM, Murrell RC. Quality of Life (QoL) in severely disabled multiple sclerosis patients: comparison of three QoL measures using

multidimensional scaling. Quality Life Res 2001; 10(4): 371–37810. Gruenewald DA, Higginson IJ, Vivat B, Edmonds P, Burman RE. Quality of life measures for the palliative care of people severely affected by multiple sclerosis: a

systematic review. Mult Scler 2004; 10(6): 690–70411. Kuspinar a, Mayo NE. Do generic utility measures capture what is important to the quality of life of people with multiple sclerosis? Health Qual Life Outcomes

2013; 11:7112. Giovannetti AM, Pietrolongo E, Giordano A, et al. Individualized quality of life of severely affected multiple sclerosis patients: practicability and value in comparison

with standard inventories. Qual Life Res 2016. DOI 10.1007/s11136-016-1303-9

L14. Patient reported outcomes (PROs)

Alessandra SolariUnit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy

36

In 2001, the World Health Organisation (WHO) developed the International Classification of Functioning, Disability and Health (ICF)as an addition to the International Classification of Diseases (ICD). Whereas the ICD classifies diseases, the ICF classifies health andfunctioning. The ICF is based on a bio-psycho-social perspective. It provides a comprehensive universal framework for thedescription and assessment of health- and health-related domains of functioning and allows a shared terminology between healthprofessionals. 1454 different categories are described : body functions, body structures, activities, participation and environmentalfactors.

To be useful, practical tools needed to be tailored (Üstün B et al., 2004). To implement and facilitate the use of the ICF in clinicalpractice validated Core Sets for several diagnoses as well as contexts have been developed (Coenen et al., 2011). ICF Core Sets arefractions of the ICF relevant for a specific health condition or a specific context. These Core Sets include as few categories as possiblefor ease of use and as many as necessary to sufficiently cover the spectrum of functional limitations experienced by these groupsof people. They serve as international standards for measuring and reporting.

The development of the ICF Core Sets for Multiple sclerosis (MS) has been a cooperative project between the Rehabilitation CentreValens, the ICF Research Branch, the WHO, the Multiple Sclerosis International Federation (MSIF) and the International Society ofPhysical Medicine and Rehabilitation (ISPRM). The results of a systematic literature review, a qualitative focus group study, an expertsurvey and a multicentre cross-sectional empirical study provided the basis for a multistage consensus conference in Valens in 2008.21 experts from different health professions from 16 countries established a Comprehensive and a Brief ICF Core Set for MS (Coenenet al., 2011). These preliminary Sets have been validated since in several studies by different professions (Berno et al., 2012) and thefinal versions have been published. These can be used for clinical decision making, choice of assessements, goal setting,documenting guidelines as well as for implementing a patient centred and evidence based rehabilitation.

L15. ICF core set

Andrea WeiseDepartment of Neurorehabilitation, Valens Clinic Rehabilitation Center, Valens, Switzerland

37

ObjectivesDuring recent years it has become clear that persons with multiple sclerosis (PwMS) benefit from physical exercise. The influencesof exercising on immunological functions, fatigue and cardiorespiratory values are still controversially discussed. However since thelast 15 years exercise therapy has become an important aspect of standardized rehabilitation in PwMS. Physical exercises performedwithin these programs are often practiced on bicycle ergometers, as progressive resistance training or combined exercise therapy.

MethodsThis talk addresses the following issues: (a) The role of exercise and sports therapy during multidisciplinary rehabilitation with PwMS; (b) the importance of standardized endurance and resistance training during rehabilitation in PwMS; (c) the identification of the main triggers to quantify exercise intensities during rehabilitation.

ResultsPractical experiences of the Rehabilitation Center Valens concerning MS-specific endurance and progressive resistance training arepresented. Case presentations (videos) highlight the area of sports therapy in clinical practice with MS patients.

ConclusionManagement of the main training procedures (quantification of exercise intensities) regarding an adequate exercise programme withPwMS during a rehabilitative stay.

S4. Sport therapy

Jens BansiDepartment of Therapy, Valens Clinic Rehabilitation Center, Valens, Switzerland

38

Equestrian Rehabilitation (RE) represents a valid instrument of intervention abilitative and rehabilitative capable of offering variouspossibilities of application , both in the neuro-motor field and in the cognitive and relational field.

It represents a complex therapeutic manner which needs the use of a horse, an adequate therapeutic setting (stables, work field),different instruments useful both for the harness of the horse (saddles, mouthpiece) and for the cleaning and care of the horses; itrequires the collaboration of specialized staff, both from the medical and care viewpoint and from the sectorial and specific viewpointfor what regards to the horses.

The develop of this rehabilitative method began in the 1960’ and fastly spreaded, and in 1974 gave birth to the International Societyof Equestrian Rehabilitation, which in 1975 for the first time (and later every three years) promoted the International TherapeuticRiding Congress, which still nowadays represents a reference for experimentations, studies and researches in this field.

Nowadays the RE is recognized as a rehabilitative method that lies on solid medical and scientific basis, and it is largely used allover the world.

In Italy there are about 150 Centres of RE, but just a few are in hospital complex, and manly associated to the National ItalianAssociation of Equestrian Rehabilitation (A.N.I.R.E.) .

It is hard to imagine how an animal could be an excellent “instrument” abilitative and rehabilitative and a peerless coworker. Yet itis now largely assessed the efficacy of the horse, gifted of muscular strength, confidential nature, armonious movements, slownessand speed, impetuosity and boldness, to provide useful stimulus to the postural reorganisation to the stimulation of balance, themuscular strengthen, the walk framework, the achievement of personal autonomy in daily activities for the people who entrust toits care.

In 2001 the horse, in spite of prejudices and restraints as alternative therapy, succeded in entering in the Clinical RehabilitativeMedical Records of the Physical and Rehabilitative Medicine of Don Carlo Gnocchi Foundation, meeting the assessment whichcomposes this Medical Record, exactly as the other rehabilitative methods. So many individualized Rehabilitative Program for peopleaffected by Multiple Sclerosis have been structured.

The structuring of an effective Rehabilitative Program is characterized by the specific choice of the horse and its use in individualtherapies, in doing the trick riding, in section, which is an essential prerequisite in order to achieve both the aim evidenced in theclinical evaluation and the mid-term and long-term goals.

Results can be assessed through the Evaluation Scales commonly used in Rehabilitation, as the Functional Independence Measure(F.I.M.), that is extremely useful and easy to use monitor the Rehabilitative Program with the horse.

The RE allows to acquire specific competences in the equestrian field, and to provide to patients new knowledge and experiencesthat turn into improvement of autonomy, as also detectable by caregivers (parents, relatives, educators, therapeutic allies). Suchacquisitions, in fact, if exported out of the therapeutic setting, produce extremely positive consequence in the social field.

Stimulating the reactions of balance on the horse, which reproduces human walk, allows to make a rehabilitative intervention in analready dynamic situation. The person will transfer and use these stimuli during walking: harness and take care of the horse in orderto dress and take care of himself, ride the horse to ride a bike.

The goals achieved strengthen the person’s self-esteem and the personal spirit of initiative, deeply modifying the attitude toward life,enabling new perspectives of independence and human relationship.

The horse becomes a very important friend to take care of, for which overtaking social and architectural barriers. The relationshipof affection that borns between the patient and his horse and, consequently, also with the therapeutic allies, produces new energies.Going to see one’s horse with a pack of carrots means having overtaken the discomfort of going to the supermarket with awheelchair.

The RE allows to reach functional and social outcomes and “riding” a new perspective of life.

S5. Hippotherapy

Antonella ArtusoDon Gnocchi Foundation, Milan, Italy

All EXCEMED programmes are organized solely to promote the exchange and dissemination of scientific and medical information. No forms of promotionalactivities are permitted. There may be presentations discussing investigational uses of various products. These views are the responsibility of the namedspeakers, and do not represent an endorsement or recommendation on the part of EXCEMED. This independent programme is made possible thanks to aneducational grant received from Merck KGaA, Darmstadt, Germany

Improving the patient's life through medical educationwww.excemed.org

EXCEMED - Excellence in Medical Education Headquarters14, Rue du Rhône - 1204 Geneva, SwitzerlandRepresentative OfficeSalita di San Nicola da Tolentino 1/b - 00187 Rome, ItalyT +39 06 420413 1 - F +39 06 420413 677

Copyright © EXCEMED, 2016. All rights reserved.

Residential course on rehabilitation in multiple sclerosis · neurorehabilitation techniques in...

Documents

Transcript of Residential course on rehabilitation in multiple sclerosis · neurorehabilitation techniques in...